Augestad, Cogent Psychology (2017), 4: 1319652https://doi.org/10.1080/23311908.2017.1319652

HEALTH PSYCHOLOGY | REVIEW ARTICLE

Self-concept and self-esteem among children and young adults with visual impairment: A systematic reviewLiv Berit Augestad1,2*

Abstract: The purpose of the study was to summarize current scientific knowledge relating to self-concept and self-esteem among children and young adolescents with visual impairment (VI). A systematic review was conducted of articles pub-lished between 1998 and 2016. A total of 26 publications, representing 15 countries, met the inclusion criteria, and 24 of the studies had used a cross-sectional design. Some studies found that the age and degree of vision loss influenced perceived self-esteem. In general, independence in mobility, parenting style, social support, and friendship was reported as important for children with VI to enhance their self-con-cept and self-esteem. To be able to provide opportunities for a successful develop-ment and good self-evaluation, we need more knowledge and further longitudinal observation studies and randomized clinical trials with high quality to increase the possibilities to draw conclusions about cause and effect.

Subjects: Psychological Science; Social Psychology; Developmental Psychology

Keywords: vision loss; visual impairment; self-esteem; self-concept; review

*Corresponding author: Liv Berit Augestad, Faculty of Medicine and Health Science, Department of Neuromedicine and Movement Science (INB), The Norwegian University of Technology and Science (NTNU), NO-7491 Trondheim, Norway; Department of Visual Impairment, Statped midt, Heimdal, NorwayE-mail: liv.berit.augestad@ntnu.no

Reviewing editor:Stefan Elmer, University of Zurich, Switzerland

Additional information is available at the end of the article

ABOUT THE AUTHORLiv Berit Augestad (PhD) is a professor at the Department of Neuromedicine and Movement Science, at the Faculty of Medicine and Health Sciences, Norwegian University of Technology and Science (NTNU), Trondheim, Norway. In addition, she has a part-time position at the Department of Visual Impairment, Statped Midt, Heimdal, Norway.

Her main research area at NTNU is physical activity and health. Since 1994, she has also focused on mental and physical health among people with visual impairment. Statped’s regional offices are responsible for providing advice and support in special education for students with visual impairment. In Norway, all students with visual impairment are fully integrated in the mainstream schools. She has published handbooks, and peer-reviewed papers in international journals, as well as the results of population-based epidemiological studies and systematic reviews in the field of vision and health.

PUBLIC INTEREST STATEMENTHow do children with visual impairment perceive their self-esteem? Children with vision loss may have reduced mobility, fewer opportunities to learn social skills, greater independency on help, and experience loneliness. Moreover, less participation in leisure-time activities with their significant others may contribute to them having an increased risk of mood disorders. Additionally, children with severe vision loss may find it hard to predict other people’s behavior, reactions, and emotions from their facial expressions. A person’s self-esteem may depend on their psychological adjustment, quality of life, adaptive behavior, relationships with friends, motivation and success in life, among other factors. Low self-esteem may ensue if there is a discrepancy between a person’s expectations and their perception of their adequacy. Children with vision loss may have lower self-esteem due if their challenges in life differ from those of sighted children. However, the self-evaluation, social comparison, and identity of children with different visual statuses may vary.

Received: 30 September 2016Accepted: 11 April 2017First Published: 20 April 2017

© 2017 The Author(s). This open access article is distributed under a Creative Commons Attribution (CC-BY) 4.0 license.

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Liv Berit Augestad

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Augestad, Cogent Psychology (2017), 4: 1319652https://doi.org/10.1080/23311908.2017.1319652

1. IntroductionRosenberg (1979) and Harter (1993) both claim that a person who perceives him- or herself as com-petent in domains in which he or she aspires to excel will have positive self-esteem. The framework for and definition of self-esteem used by Harter and Rosenberg has much in common with the con-cept of self-esteem. Self-esteem can be conceptualized as the level of global regard that a person has for him- or herself as an individual (Leary & Baumeister, 2000).

Further, self-esteem may play a profound role in all aspects of a child’s development (Brooks, 1992; Olsen, Breckler, & Wiggens, 2008). The term self-esteem may reflect a person’s overall emo-tional evaluation of his or her worth and a person’s sense of pride and is closely associated with his or her self-consciousness and psychological well-being (Olsen et al., 2008). This is a judgment of the self as well as an attitude toward the self. Therefore, a person’s self-esteem may be dependent upon his or her psychological adjustment, the quality of life, adaptive behavior, relationships with friends, motivation, school performance, and success in life (Brooks, 1992; Papadopoulos, Metsiou, & Agaliotis, 2011; Saigal, Lambert, Russ, & Hoult, 2002). Self-esteem is often defined as the evaluative component of self-concept (Pope, Mchale, & Craighead, 1988). Low self-esteem may ensue if there is a discrepancy between a person’s expectations and his or her perception of adequacy.

Alexander (1996) claims that adjusting to the social impact of vision loss requires the person to adjust positively to life’s demands to maintain a positive self-concept. To facilitate the successful inclusion in society of children who are visually impaired, it is important to gain a better understand-ing of the psychological challenges they face. According to Tuttle and Tuttle (2004, p. 73), “the psy-chological principles involved in the dynamics of the development of one’s self-concept and self-esteem among sighted are equally applicable to persons who are blind.” However, children with visual impairment (VI) may have lower self-esteem because the challenges they face in life differ from those faced by sighted children (Alexander, 1996; Hadidi & Al Khateeb, 2013; Konarska, 2007). Roy and MacKay (2002) claim that sighted people might have more difficulties understanding people with low vision than those who are blind. Therefore, self-evaluation, social comparison, and identity may vary between children and young adults who differ in their visual status (Huurre & Aro, 1998; Pinquart & Pfeiffer, 2013). Furthermore, the self-perception of adolescents with low vision could be undermined by any negative attitudes of his or her peers, parents, and teachers.

Additionally, different countries have different school systems, cultures, and social and financial support systems for persons who are visually impaired. Some children with VI live in residential schools for the blind, while others are integrated into mainstream schools. These differences can also affect a child’s perception of his or her moral, personal, physical, and social self-esteem (Bracken, 1995).

With increasing age, children naturally tend to seek more involvement with friends than with their parents or siblings, helping them to develop independence and well-being by experiencing different activities (Huurre & Aro, 1998; Olsen et al., 2008). Due to functional restrictions, especially problems with mobility and orientation, children with VI may perceive more stress in their personal and social development compared with sighted children. Their reduced ability to evaluate another person’s body language may influence the reaction and feedback they encounter in some situations. Children who are visually impaired may be less socially mature and more egocentric than sighted children, since they often have difficulties observing and imitating their peers which, in turn, may interfere with their ability to develop a positive sense of self-esteem (Tuttle & Tuttle, 2004).

Saigal et al. (2002) claim that the self-esteem and social and emotional well-being of children are important domains that one should monitor closely in children considered to have higher risk of problems with adjustment. They also state: “there is now consensus that all aspects of a child’s daily activities, motivation, and behavior are impacted by the child’s self-esteem” (Saigal et al., 2002, p. 433). In addition, self-perception and feedback from important others are factors that affect whether the level of a person’s self-esteem is high or low. Both self-concept and self-esteem play

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Augestad, Cogent Psychology (2017), 4: 1319652https://doi.org/10.1080/23311908.2017.1319652

important roles throughout all developmental phases from childhood to adult life. Beaty (1991) sug-gests that young people with VI have lower self-concept than their peers without VI, in a number of dimensions.

To the best of my knowledge, the peer-reviewed literature does include no review of self-concept or self-esteem among children and young adults with VI. Since peer-reviewed, published papers report mixed results, I considered it important to conduct a systematic review. Accordingly, the aim of this research and review was to summarize current knowledge of self-concept and self-esteem among children and young adults with VI.

2. Methods

2.1. Search strategyFirst, I used the databases Psychology and Behavioral Sciences Collection, PsycNET, PubMed, Eric, Google Scholar, Web of Science, and MEDLINE to identify published articles on self-esteem and self-concept among children with VI. I searched the databases using the following search terms: VI, blind, low vision, self-esteem, self-concept, self-worth, and psychosocial development. Second, I conducted a manual search of the reference lists in the retrieved articles.

2.2. Criteria for inclusion and exclusionI included studies of school-age children and young adults with VI in the age range 5–25 years. I chose the upper limit of the age range to be 25 years because many children with VI often need more years to graduate from high school than do sighted children. I restricted articles to those that: were written in English, were based on original data, had been peer-reviewed, and had been pub-lished between January 1998 and January 2014 inclusive.

I excluded articles on children and young adults with VI with comorbidity or multiple disabilities. Additionally, I excluded studies that: included only one subject, focused mainly on social support, or were duplicates. Thus, I included a total of 26 studies in the review.

2.3. Data extractionI used a standardized protocol and abstraction form. For each publication, I recorded the first-au-thor’s name, publication year, the country in which the study had been conducted, the age and number of people in the study, the number of children with, and the number without VI in the study, the main methods for measuring self-concept and self-esteem, the definition of VI used, the school or college type, and the main results.

2.4. Evaluation of the studiesI summarized the results of my research in a table, and used the Quality Assessment Tool for Studies with Diverse Designs (QATSDD) to evaluate the 26 selected studies (Sirriyeh, Lawton, Gardner, & Armitage, 2012). The tool, which was developed to assess the quality of studies on one topic but using different approaches or designs, has been found to have good reliability and validity (Sirriyeh et al., 2012). I used the version with 14 QATSDD items related to quantitative studies. Each item was rated on a four-point scale ranging from “not at all” (0), “very slightly” (1), “moderate” (2), to “completely” (3), with a maximum score of 42. The percentage score was calculated by dividing the actual score by the maximum score (i.e. 42). Papers scoring over 75% were considered “high quality,” 50–75% “good,” 50–25% “moderate,” and those below 25% “poor.” The quality ratings are presented in Table 1.

3. Results

3.1. General resultsThe 26 articles included for evaluation assess either self-concept or self-esteem and the respective authors are listed in Table 1.

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Augestad, Cogent Psychology (2017), 4: 1319652https://doi.org/10.1080/23311908.2017.1319652Ta

ble

1. C

hara

cter

istic

s of

the

eval

uate

d st

udie

s of

sel

f-es

teem

and

sel

f-co

ncep

tAu

thor

(s)

(Pub

licat

ion

year

)

Met

hods

1M

ain

resu

lts (Q

ualit

y ra

ting

acco

rdin

g to

the

Qual

ity A

sses

smen

t To

ol fo

r Stu

dies

with

Div

erse

Des

igns

(QAT

SSD)

)Sa

mpl

eM

ain

mea

sure

men

tsDe

finiti

on of

VI2

Scho

ol ty

pe

Coun

try

Datt

a an

d Ta

lukd

ar (2

016)

Aust

ralia

25 V

ITe

nnes

see

Self-

Conc

ept

Scal

e (T

SCS)

Visu

al a

cuity

from

6/

18 o

r les

s to

3/6

0 an

d le

ss (b

lind)

Spec

ialis

t and

m

ains

trea

m

No d

iffer

ence

s be

twee

n ge

nder

and

sco

res

on s

elf-

conc

ept.

The

maj

ority

of t

he

stud

ents

with

VI s

core

d lo

w o

n al

l dim

ensio

ns o

n se

lf-co

ncep

t(G

ood)

Age:

15–

25 y

ears

Papa

dopo

ulos

(2

014)

Gree

ce

84 V

I51

VI f

rom

birt

h49

VI a

cqui

red

at a

la

ter a

geAg

e: y

oung

adu

lts

Rose

nbor

g Se

lf-Es

teem

Sc

ale

Rott

er In

tern

al-E

xter

nal

Locu

s of

Con

trol

Sca

le

(IE-

LOC)

Visu

al a

cuity

, visu

al

field

, rea

ding

med

ia,

age

at lo

ss o

f sig

ht,

rece

ncy

of v

ision

loss

42 b

lind,

42

low

vi

sion

Not m

entio

ned

The

signi

fican

t pre

dict

ors

of s

elf-

este

em w

ere

visio

n st

atus

, age

loss

of s

ight

, rec

ency

of

visi

on lo

ss a

nd e

duca

tiona

l lev

el. S

igni

fican

t pre

dict

ors

of L

OC

wer

e vi

sion

stat

us

and

inde

pend

ent m

ovem

ent.

High

er s

elf-

este

em a

mon

g yo

ung

adul

ts w

ith

blin

dnes

s co

mpa

red

with

low

visi

on g

roup

, and

am

ong

the

cong

enita

l VI g

roup

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mpa

red

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thos

e w

ith re

cent

visi

on lo

ss o

r in

the

low

visi

on g

roup

(Mod

erat

e)

Pinq

uart

and

Pf

eiffe

r (20

13)

Germ

any

178

VI (2

4 w

ith

seco

nd d

isabi

lity)

526

sight

edM

ean

age:

16

year

s

EIPQ

3 for i

dent

itySu

bsca

les

SBSS

S4 for s

ocia

l su

ppor

tSD

Q5 fo

r beh

avio

r pr

oble

ms

WHO

6 defi

nitio

nDS

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RSFV

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diff

eren

ce in

per

ceiv

ed id

entit

y be

twee

n ch

ildre

n. L

ower

per

ceiv

ed id

entit

y am

ong

child

ren

with

con

geni

tal V

I com

pare

d w

ith c

hild

ren

with

acq

uire

d VI

. Pe

rcei

ved

iden

tity

incr

ease

d w

ith in

crea

sed

age.

Bet

ter p

aren

tal e

duca

tion

and

supp

ort f

rom

pee

rs, f

ewer

beh

avio

ral p

robl

ems

(Hig

h)

Mish

ra a

nd

Sing

h (2

012)

Indi

a

100

VI10

0 sig

hted

Self-

Conc

ept I

nven

tory

by

Moh

sin

Self-

Confi

denc

e In

vent

ory

by P

ande

y

Not m

entio

ned

Diffe

rent

sc

hool

s in

Del

hiSi

gnifi

cant

low

er s

elf-

conc

ept a

mon

g st

uden

ts w

ith V

I. No

sig

nific

ant d

iffer

ence

s in

se

lf-co

ncep

t bet

wee

n bo

ys a

nd g

irls.

The

maj

ority

of s

tude

nts

with

VI h

ad a

vera

ge

self-

confi

denc

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ut g

reat

er s

elf-

confi

denc

e am

ong

sight

ed p

artic

ipan

ts(M

oder

ate)

Pand

ith e

t al.

(201

2)In

dia

N =

150

50 V

I50

hea

ring

impa

ired

50 c

rippl

ed s

econ

dary

sc

hool

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r and

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rms

Self-

Conc

ept I

nven

tory

, Sh

ah’s

Leve

l of A

spira

tion

tool

Not m

entio

ned

Vario

us

seco

ndar

y sc

hool

s

Sam

e le

vel o

f rea

l sel

f and

asp

iratio

n am

ong

the

thre

e gr

oups

. Due

to lo

wer

se

lf-co

ncep

t and

leve

l-of-

aspi

ratio

n sc

ores

, the

ir ac

hiev

emen

ts c

ame

out v

ery

low

(Mod

erat

e)

Hald

er a

nd

Datt

a (2

012)

Indi

a

60 V

I10

0 sig

hted

Ag

e: 1

5–18

yea

rs

Gene

ral I

nfor

mat

ion

Sche

dule

, PHC

SCS9

Visu

al a

cuity

≤ 6

/60

or 2

0/20

0Bl

ind

MS10

DSFV

ISi

ghte

d ad

oles

cent

s ha

d hi

gher

ove

rall

self-

conc

ept s

core

s co

mpa

red

with

thei

r bl

ind

peer

s, in

clud

ing

the

dom

ains

phy

sical

app

eara

nce,

pop

ular

ity, h

appi

ness

and

sa

tisfa

ctio

n(M

oder

ate)

Hald

er a

nd

Datt

a (2

011)

Indi

a

60 V

I10

0 sig

hted

Age:

15–

18 y

ears

PHCS

CS

Visu

al a

cuity

≤ 6

/60

or 2

0/20

0Bl

ind

MS

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ILo

wer

sel

f-co

ncep

t, in

clud

ing

the

dom

ains

phy

sical

app

eara

nce,

pop

ular

ity,

happ

ines

s, a

nd s

atisf

actio

n in

all

yout

hs w

ith V

I. Si

ghte

d m

ale

adol

esce

nts

scor

ed

high

est o

n ov

eral

l sel

f-co

ncep

t(M

oder

ate)

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et a

l. (2

011)

Egyp

t

100

VI

Age:

12–

18 y

ears

Soci

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nom

ic S

cale

Rose

nbor

g Se

lf-Es

teem

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ale

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lity

of L

ife S

cale

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entio

ned

El-N

oor S

choo

lCh

ildre

n w

ith V

I fro

m h

igh

soci

al c

lass

es h

ad a

hig

her q

ualit

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life

and

nor

mal

se

lf-es

teem

com

pare

d w

ith o

ther

chi

ldre

n w

ith V

I(G

ood)

Bola

t et a

l. (2

011)

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ey

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I40

sig

hted

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n ag

e: 1

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year

s

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ren’

s De

pres

sion

Inve

ntor

yPH

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lber

ger T

rait

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ety

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ntor

y fo

r Chi

ldre

n

Cong

enita

l com

plet

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sual

impa

irmen

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for

child

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d to

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hted

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dole

scen

ts w

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sim

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n le

vels

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se

lf-co

ncep

t cha

ract

erist

ics,

but

hig

her a

nxie

ty le

vels

(Goo

d)

(Con

tinue

d)

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Augestad, Cogent Psychology (2017), 4: 1319652https://doi.org/10.1080/23311908.2017.1319652

Auth

or(s

) (P

ublic

atio

n ye

ar)

Met

hods

1M

ain

resu

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ualit

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rdin

g to

the

Qual

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sses

smen

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ol fo

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dies

with

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erse

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try

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0)Ke

nya

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rtia

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tota

lly b

lind

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s ei

ght

Self-

Desc

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n Q

uest

ionn

aire

Indi

vidu

al

Eval

uatio

n (S

DQI)

Acad

emic

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st (A

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t16

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ecia

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,82

inte

grat

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S, 2

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clus

ive

prog

ram

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sco

red

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er th

an b

oys

on s

elf-

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nd h

ence

in a

chie

vem

ent t

ests

than

th

eir m

ale

coun

terp

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am

ong

pupi

ls w

ith V

I. St

uden

t with

hig

her s

elf-

conc

ept

scor

ed h

ighe

r on

achi

evem

ent.

Pupi

ls w

ho w

ere

tota

lly b

lind

had

low

er s

elf-

conc

ept

than

pup

ils w

ith lo

w v

ision

(Hig

h)

Bow

en (2

010a

)Un

ited

King

dom

60 V

IAg

e: 6

–14

year

s B/

G ST

EEM

11 fo

r sel

f-es

teem

and

locu

s of

co

ntro

l

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len

Char

t 1/1

20

defin

ed a

s se

vere

VI,

6/9

defin

ed a

s m

ild

VI

MS

Self-

este

em o

f the

maj

ority

of c

hild

ren

with

VI:

norm

al o

r hig

h le

vel.

High

er

self-

este

em in

girl

s co

mpa

red

to b

oys.

Deg

ree

of V

I and

age

may

affe

ct s

elf-

este

em(M

oder

ate)

Bow

en (2

010b

)Un

ited

King

dom

4 VI

Age:

7–1

2 ye

ars

B/GS

TEEM

for s

elf-

este

emSn

elle

n Ch

art

MS

Six

mon

ths’

educ

atio

nal i

nter

vent

ion

over

hal

f of a

sch

ool t

erm

impr

oved

the

self-

este

em o

f chi

ldre

n w

ith V

I who

had

low

or v

ery

low

sel

f-es

teem

from

bas

elin

e(M

oder

ate)

Gara

igor

dobi

l an

d Be

rnar

ás

(200

9)Sp

ain

29 V

I61

no

VIAg

e: 1

2–17

yea

rs

LAEA

12

RSES

13

SCL-

90-R

14

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-FFI

15

VI: 2

4% v

ision

leve

l be

twee

n 0.

4 an

d 0.

3,

28%

bet

wee

n 0.

25

and

0.12

, and

35%

0.

1 or

less

Eye

di

agno

stic

test

Cent

re o

f Re

sour

ces

for

the

Educ

atio

nal

Incl

usio

n (C

RI)

MS

No s

igni

fican

t diff

eren

ces

in s

elf-

conc

ept a

nd s

elf-

este

em, b

ut th

e ch

ildre

n w

ith

seve

re V

I sco

red

signi

fican

tly h

ighe

r in

psyc

hopa

thol

ogic

al sy

mpt

oms.

Girl

s w

ith

seve

re V

I sco

red

low

er in

sel

f-es

teem

. Hig

her s

core

s on

sel

f-es

teem

: cor

rela

ted

with

hi

gher

sco

res

on e

xtro

vers

ion.

Low

psy

chot

icism

, hig

h ex

trav

ertio

n, a

nd lo

w h

ostil

ity

wer

e id

entifi

ed a

s pr

edic

tors

of h

igh

self-

conc

ept

(Hig

h)

Shap

iro e

t al.

(200

8)Un

ited

Stat

es

43 V

I9

B1—

Athl

etes

7 B2

—At

hlet

es14

B3—

Athl

etes

13 u

nkno

wn

−33

Age:

8–1

4 ye

ars

−10

Age:

15

year

s an

d ov

er

Self-

Perc

eptio

n Pr

ofile

for

Child

ren

(SPP

C) a

nd

Adol

esce

nts

(SPP

A)

Snel

len

Char

t and

as

sess

men

t of fi

eld

of v

ision

Unite

d St

ates

As

soci

atio

n of

Blin

d At

hlet

es d

efini

tion

Part

icip

ants

at

tend

ed a

one

w

eek

sum

mer

ca

mp

for

indi

vidu

als

with

VI

Child

ren

with

VI d

iscou

nted

the

impo

rtan

ce o

f phy

sical

app

eara

nce,

ath

letic

co

mpe

tenc

e, a

nd s

ocia

l acc

epta

nce

and

had

mod

erat

ely

high

ratin

gs o

n gl

obal

or

over

all s

elf-

wor

th(H

igh)

Al-Z

youd

i (2

007)

Jord

an

23 lo

w v

ision

Age:

12–

17 y

ears

TSCS

16

Min

neso

ta M

ultip

hase

Pe

rson

ality

Inve

ntor

y (M

MPI

)

WHO

defi

nitio

nM

SYo

uths

with

VI h

ad h

ighe

r sel

f-co

ncep

t in

phys

ical

app

eara

nce

and

perfo

rman

ce,

low

er s

elf-

conc

ept i

n so

cial

rela

tion,

fam

ily in

volv

emen

t, m

oral

and

beh

avio

r to

self

for g

irls

com

pare

d to

boy

s(G

ood)

Lifs

hitz

et a

l. (2

007)

Isra

el

40 V

I41

sig

hted

Age:

13–

18 y

ears

“I a

m/H

e is”

an

Isra

eli

Que

stio

nnai

reNo

ttin

gham

Adj

ustm

ent

Scal

eQ

ualit

y of

Frie

ndsh

ip S

cale

US d

efini

tions

(N

atio

nal E

ye

Inst

itute

, 200

2)

20 R

SFVI

20 V

I in

Publ

ic

Scho

ol

Sim

ilar s

elf-

conc

ept p

rofil

e fo

r the

ado

lesc

ents

(Hig

h)

Shap

iro e

t al.

(200

5)Un

ited

Stat

es

43 V

I9

B1—

Athl

etes

7 B2

—At

hlet

es14

B3—

Athl

etes

13 u

nkno

wn

33 A

ge: 8

–14

10 A

ge: 1

5 ye

ars

and

over

Self-

Perc

eptio

n Pr

ofile

for

Child

ren

(SPP

C) a

nd

Adol

esce

nts

(SPP

A)

Snel

len

Char

t and

as

sess

men

t of v

ision

fie

ld T

he d

efini

tion

from

the

US

Asso

ciat

ion

for B

lind

Athl

etes

Part

icip

ants

at

tend

ed a

one

w

eek

sum

mer

ca

mp

for

indi

vidu

als

with

vi

sual

im

pairm

ent

Diffe

renc

es in

the

perc

eive

d co

mpe

tenc

e of

the

girls

, but

not

the

boys

, aft

er th

ey

atte

nded

one

-wee

k su

mm

er c

amp.

No

diffe

renc

es in

the

perc

eptio

ns o

f com

pete

nce

with

age

(Hig

h)

Tabl

e 1.

(Con

tinue

d)

(Con

tinue

d)

Page 6 of 12

Augestad, Cogent Psychology (2017), 4: 1319652https://doi.org/10.1080/23311908.2017.1319652

Auth

or(s

) (P

ublic

atio

n ye

ar)

Met

hods

1M

ain

resu

lts (Q

ualit

y ra

ting

acco

rdin

g to

the

Qual

ity A

sses

smen

t To

ol fo

r Stu

dies

with

Div

erse

Des

igns

(QAT

SSD)

)Sa

mpl

eM

ain

mea

sure

men

tsDe

finiti

on of

VI2

Scho

ol ty

pe

Coun

try

Griffi

n-Sh

irley

an

d Ne

s (2

005)

Unite

d St

ates

71 V

I88

sig

hted

Age:

8–1

4 ye

ars

CSEI

17 s

hort

form

for

self-

este

emIE

CA18

for e

mpa

thy

CABS

19 fo

r bon

ding

with

pe

ts

The

best

cor

rect

ion

of V

I stil

l affe

cts

educ

atio

nal

perfo

rman

ce

RSFV

INo

diff

eren

ces

in s

elf-

este

em, e

mpa

thy

tow

ard

othe

rs, a

nd b

ondi

ng w

ith p

ets

betw

een

child

ren

(Hig

h)

Roy

and

Mac

Kay

(200

2)Sc

otla

nd a

nd

Unite

d Ki

ngdo

m

16 b

lind

or lo

w v

ision

Age:

18–

34 y

ears

(m

ean

age

23 y

ears

)

Twen

ty S

tate

men

ts T

est

(TST

) (se

lf-pe

rcep

tion)

IELO

C

Self-

defin

ition

Colle

geA

gene

rally

pos

itive

vie

w o

f sel

f-em

erge

d, b

ut n

egat

ive

TST

resp

onse

s fo

cusin

g on

di

sabi

lity

occu

rred,

som

etim

es a

ssoc

iate

d w

ith d

eter

iora

ting

visio

n lo

ss a

nd re

cenc

y lo

ss. H

ighl

y ex

tern

al L

OC

resp

onse

s. E

xper

ienc

e lo

w v

ision

may

be

mor

e fra

ught

with

an

xiet

y an

d se

lf-ev

alua

tion

and

iden

tity

than

blin

dnes

s(M

oder

ate)

Kef (

2002

)Ne

ther

land

s31

6 VI

(60

blin

d, 5

8 se

vere

VI,

198

mod

erat

e VI

)49

5 sig

hted

Age:

14–

24 y

ears

Rose

nber

g Se

lf-es

teem

Sc

ale

(RSE

S)Lo

cus

of C

ontr

ol

Cons

truc

t20

Func

tiona

l Visi

on

Scal

eRS

FVI

The

adol

esce

nts

with

VI r

epor

ted

a sl

ight

ly h

ighe

r lev

el o

f sel

f-es

teem

, and

mor

e di

fficu

lties

to m

ake

frien

ds(H

igh)

Lope

z-Ju

stic

ia

et a

l. (2

001)

Spai

n

58 c

onge

nita

l low

vi

sion

58 s

ight

edAg

e gr

oups

: 4–7

, 8–1

1,

and

12–1

7 ye

ars

PAI21

for a

ge 4

–7 y

ears

SCSD

Q22

for a

ge 8

–11

year

sTen

ness

e Se

lf-Co

n-ce

pt S

cale

(TSC

S) fo

r age

12

–17

year

s

WHO

defi

nitio

nM

SLo

wer

sel

f-es

teem

am

ong

child

ren

with

con

geni

tal l

ow v

ision

com

pare

d to

sig

hted

(Goo

d)

Card

inal

i and

D’

Allu

ra (2

001)

Unite

d St

ates

31 V

IAg

e: 1

8–23

yea

rs17

mot

hers

Pare

ntal

Aut

ority

Q

uset

ionn

aire

(PAQ

for

pare

ntin

g st

yle

(sel

f-re

port

an

d re

port

from

mot

hers

)TS

CS

Not m

entio

ned

Finish

ed s

choo

lPa

rent

ing

styl

e re

late

d to

chi

ldre

n’s

self-

este

em(H

igh)

Huur

re e

t al.

(200

1)Fin

land

115

VI60

7 sig

hted

co

ntro

lsAg

e: 1

2–17

yea

rs

Beck

Dep

ress

ion

Inve

ntor

ySe

lf-es

teem

Sca

le

deve

lope

d fo

r Fin

nish

sc

hool

stu

dent

s, s

cale

s fo

r re

latio

nshi

ps

Oph

thal

mol

ogic

al

info

rmat

ion

from

the

Finni

sh R

egist

er o

f Vi

sual

Impa

irmen

t

MS

The

impa

ct o

f rel

atio

nshi

ps w

ith fr

iend

s on

dep

ress

ive

sym

ptom

s w

as m

edia

ted

thro

ugh

self-

este

em. U

nlike

the

cont

rols

, rel

atio

nshi

p w

ith p

aren

ts w

as n

ot a

n ex

plan

ator

y fa

ctor

of d

epre

ssio

n in

ado

lesc

ents

with

VI

(Hig

h)

Gron

mo

and

Auge

stad

(2

000)

Norw

ay a

nd

Fran

ce

8 No

rweg

ian

and

12

Fren

ch (b

lind)

, 41

Norw

egia

n an

d 43

Fr

ench

(con

trol

s)Ag

e: 1

3–16

yea

rs

Shor

tene

d ve

rsio

ns

HSPP

A23 fo

r Sel

f-Co

ncep

t an

d Gl

obal

Sel

f-W

orth

14 b

orn

blin

d an

d th

e re

st b

ecam

e bl

ind

late

r in

life

MS:

Nor

way

DSFV

I: Fr

ance

Sc

hool

type

or c

ount

ry h

ad n

o in

fluen

ce o

n th

e re

port

ed s

elf-

conc

ept a

nd g

loba

l se

lf-w

orth

. Sig

nific

ant d

iffer

ence

s in

glo

bal s

elf-

wor

th b

etw

een

blin

d an

d sig

hted

yo

uths

(Goo

d)

Rose

nblu

m

(200

0)Un

ited

Stat

es

10 a

dole

scen

ts w

ith V

I23

sig

hted

frie

nds

(of

the

10 a

dole

scen

ts)

Sem

i-str

uctu

red

inte

rvie

ws

and

quan

tita-

tive

data

Self-

repo

rted

low

vi

sion

or fu

nctio

nally

bl

ind

MS

Hete

roge

neity

of t

he p

opul

atio

n of

ado

lesc

ents

with

VI i

n th

eir e

xper

ienc

es o

f VI a

nd

perc

eptio

ns o

f how

VI a

ffect

ed th

eir l

ives

. Ado

lesc

ents

with

VI f

elt e

xclu

ded

and

that

ha

d a

nega

tive

impa

ct o

n th

eir s

elf-

este

em a

nd s

elf-

wor

th(G

ood)

Tabl

e 1.

(Con

tinue

d)

(Con

tinue

d)

Page 7 of 12

Augestad, Cogent Psychology (2017), 4: 1319652https://doi.org/10.1080/23311908.2017.1319652

Auth

or(s

) (P

ublic

atio

n ye

ar)

Met

hods

1M

ain

resu

lts (Q

ualit

y ra

ting

acco

rdin

g to

the

Qual

ity A

sses

smen

t To

ol fo

r Stu

dies

with

Div

erse

Des

igns

(QAT

SSD)

)Sa

mpl

eM

ain

mea

sure

men

tsDe

finiti

on of

VI2

Scho

ol ty

pe

Coun

try

Huur

re e

t al.

(199

9)Fin

land

115

VI60

7 sig

hted

Age:

12–

17 y

ears

Finni

sh 5

-poi

nt s

cale

for

self-

este

em a

nd s

ocia

l re

latio

nshi

ps

Brai

lle u

sers

defi

ned

as b

lind

MS

Frie

ndsh

ip im

prov

ed s

elf-

este

em fo

r chi

ldre

n w

ith V

I. Lo

wer

sel

f-es

teem

am

ong

girls

w

ith V

I. No

diff

eren

ce in

sel

f-es

teem

bet

wee

n bo

ys w

ith V

I and

boy

s w

ithou

t VI.

No

influ

ence

s of

sev

erity

of V

I or o

nset

of V

I on

the

self-

este

em o

f chi

ldre

n w

ith V

I(H

igh)

Tabl

e 1.

(Con

tinue

d)

1 All

stud

ies

wer

e cr

oss-

sect

iona

l stu

dies

exc

ept f

or th

e on

e by

Bow

en (2

010b

).2 V

I: vi

sual

impa

irmen

t.3 E

IPQ

: Ego

Iden

tity

Proc

ess

Que

stio

nnai

re.

4 SBS

SS: S

uppo

rt B

erlin

Soc

ial S

uppo

rt S

cale

s.5 S

DQ: S

tren

gth

and

Diffi

culti

es Q

uest

ionn

aire

.6 W

HO: W

orld

Hea

lth O

rgan

izat

ion.

7 DSF

VI: d

ay s

choo

l for

chi

ldre

n w

ith V

I.8 R

SFVI

: res

iden

tial s

choo

l for

chi

ldre

n w

ith V

I.9 P

HCSC

S: P

iers

-Har

ris C

hild

ren’

s Se

lf-Co

ncep

t Sca

le.

10M

S: m

ains

trea

m s

choo

ls.

11B/

G ST

EEM

que

stio

nnai

re: S

elf-

este

em S

cale

with

Loc

us o

f Con

trol

Item

s by

Mai

nes

and

Robi

nson

.12

LAEA

: Adu

lt an

d Ad

oles

cent

Sel

f-Co

ncep

t Adj

ectiv

e Ch

eckl

ist.

13RS

ES: R

osen

berg

Sel

f-Es

teem

Sca

le.

14SC

L-90

-R: S

ympt

om C

heck

list-

90-R

evis

ed.

15N

EO-F

FI: N

eo F

ive-

Fact

or In

vent

ory.

16TS

CS: T

enne

ssee

Sel

f-Co

ncep

t Sca

le.

17CS

EI: C

oope

r sm

ith S

elf-

este

em In

vent

ory.

18IE

CA: I

ndex

of E

mpa

thy

for C

hild

ren

and

Adol

esce

nts.

19CA

BS: C

ompa

nion

of A

nim

al B

ondi

ng S

cale

.20

Copi

ng.

21PA

I: Pe

rcep

tion

del A

utoc

once

pto

Infa

ntil.

22SC

SDQ

: Sel

f-Co

ncep

t Sca

le o

f the

Sel

f-De

scrip

tion

Que

stio

nnai

re.

23HS

PPA:

Har

ter’s

Sel

f-pe

rcep

tion

Profi

le fo

r Ado

lesc

ents

.

Page 8 of 12

Augestad, Cogent Psychology (2017), 4: 1319652https://doi.org/10.1080/23311908.2017.1319652

3.2. Study characteristicsAll of the evaluated articles report results from observational studies with a cross-sectional design, except for two that report results of interventional studies (Bowen, 2010b; Shapiro, Moffett, Lieberman, & Dummer, 2005). The study conducted by Bowen included a six-month educational intervention for four children with VI, and the study conducted by Shapiro et al. included 43 children with VI who at-tended a one-week summer camp. The articles were conducted in 15 countries. Most studies included only a small number of subjects, although 7 of the 26 studies included more than 100 participants with VI (Huurre, Komulainen, & Aro, 1999, 2001; Kef, 2002; Kotb, Gadallah, & Marzouck, 2011; Mishra & Singh, 2012; Pinquart & Pfeiffer, 2013; Were, Indoshi, & Yalo, 2010). The age range of the partici-pants, school type, definition of VI, and outcome measurements differed from study to study.

3.3. VI compared with no VIFive studies showed that children and young adults with VI scored lower on self-concept and self-esteem than did children without VI (Gronmo & Augestad, 2000; Halder & Datta, 2012; Lopez-Justicia, Pichardo, Amezcua, & Fernandez, 2001; Mishra & Singh, 2012; Rosenblum, 2000). On the other hand, seven studies did not find these differences (Bolat, Dogangun, Yavuz, Demir, & Kayaalp, 2011; Garaigordobil & Bernarás, 2009; Griffin-Shirley & Nes, 2005; Huurre et al., 1999; Konarska, 2007; Lifshitz, Hen, & Weisse, 2007; Pinquart & Pfeiffer, 2013). However, Kef (2002) found that ado-lescents with VI reported slightly higher levels of self-esteem than the sighted adolescents. Shapiro, Moffett, Lieberman, and Dummer (2008) report that children with VI had moderately high ratings of global self-worth. Pandith, Malik, and Ganai (2012) concluded that children with VI in secondary school had same level of self-esteem and aspiration as children with hearing impairments and chil-dren who were crippled.

3.4. GenderWith regard to self-esteem and self-concept, Bowen (2010a) and Were et al. (2010) found that girls with VI had better scores than boys with VI, but two other studies did not find gender differences (Datta & Talukdar, 2016; Mishra & Singh, 2012). By contrast, Al-Zyoudi (2007) found that compared with boys with low vision, girls with low vision scored higher on self-concept regarding their physical appearance but lower on self-concept in social relationships. Shapiro et al. (2005) found that girls with VI had lower perceptions of their competence than boys with VI, and although the girls’ perception of competence increased after a one-week summer camp, the boys still scored higher on competence than the girls. Three studies from Finland showed that girls with VI had lower self-esteem than girls without VI, while boys with VI seemed to be well adjusted with respect to their self-esteem (Huurre & Aro, 1998, 2000; Huurre et al., 1999). Huurre and Aro (2000) claim that the findings are indicative of different coping mechanisms or different ways of expressing health differences between boys and girls. This finding is in line with results reported by Halder and Datta (2011).

3.5. Severity and age of onsetTwo studies found that the severity of children’s VI did not influence their self-concept (Huurre et al., 1999; Pinquart & Pfeiffer, 2013); by contrast, four studies found the opposite results for self-esteem (Bowen, 2010a; Garaigordobil & Bernarás, 2009; Papadopoulos, 2014; Were et al., 2010). Pinquart and Pfeiffer (2013) found that children with congenital VI scored lower on self-identity than children with acquired VI, while Papadopoulos (2014) found the opposite results. The results of the study conducted by Roy and MacKay (2002) showed that young adults with low vision had poorer self-evaluation and identity than those who were blind. Huurre et al. (1999) found that the onset of VI did not influence the self-esteem of children with VI compared to peers with VI.

3.6. Age, parenting style, behavioral problems, and school systemThe self-esteem or self-concept of children with VI might have been affected by their parents’ edu-cation (Pinquart & Pfeiffer, 2013), parenting style (Cardinali & D’Allura, 2001), higher social class (Kotb et al., 2011), age (Pinquart & Pfeiffer, 2013), and whose other children had problem behaviors (Lopez-Justicia et al., 2001; Pinquart & Pfeiffer, 2013). Different school systems did not affect the self-concept of children with VI (Gronmo & Augestad, 2000).

Page 9 of 12

Augestad, Cogent Psychology (2017), 4: 1319652https://doi.org/10.1080/23311908.2017.1319652

3.7. Social support and friendshipSocial support, especially friendship (Huurre et al., 1999, 2001; Shapiro et al., 2008), seemed to be important for enhancing the self-esteem or self-concept of children with VI. Al-Zyoudi (2007) con-cluded that, compared with boys with low vision, girls with low vision had lower scores on self-con-cept in social relations. Bowen (2010b) conducted an educational intervention study of children with VI who had low self-esteem. Her results showed that interventions that included more cooperative teaching (“circle time” and “circle of friends”) and more learning in the classroom had a positive ef-fect. The scores on self-esteem increased.

4. DiscussionDue to different research purposes, study designs, samples, cultures, and the use of different measure-ments to evaluate self-concept and self-esteem, the results of the studies were inconsistent. However, friendship, independence in mobility, social support, and parenting style all seemed to be important for enhancing the self-concept and self-esteem of children with VI. Girls with VI appeared to have less self-esteem and a lower sense of self-concept compared with boys with VI. Children with VI may have fewer opportunities to make friends than sighted children and they may face more social isolation. As a possible consequence, they may develop emotional and communication problems (Kef, 2002). Overprotection could leave them feeling less attractive and competent, and consequently they could experience additional frustration and emotional or behavioral problems (Huurre & Aro, 1998, 2000).

Good social support, especially support from friends, may help to improve self-concept and self-esteem among children with VI (Lopez-Justicia et al., 2001; Pinquart & Pfeiffer, 2013). Opportunities for children with VI to join leisure activities and other social activities with friends are especially im-portant (Huurre & Aro, 2000). Griffin-Shirley and Nes (2005) claim that the development of self-es-teem among children and youths with VI requires an environment that provides freedom to explore and protection from danger. Self-confidence in one’s abilities is important, and therefore adults or friends need to help children with VI to find suitable leisure-time activities.

The reported importance of the degree of vision loss differed between the studies. However, most of the studies didn’t separately analyze children with mild VI. Lack of information for children with mild VI may therefore have biased some conclusions. Nevertheless, the degree of vision loss and the prognoses of the disease may interfere with evaluations of self-esteem. The inclusion of children with VI in mainstream schools did not seem to have a negative influence on their self-esteem (Gronmo & Augestad, 2000). In some countries, parents may send their child to a school for the blind, but in other countries, the only option may be a mainstream school. The results of the study conducted by Kef (2002) showed that adolescents with VI reported higher self-esteem than sighted adolescents. One reason for those results may be that, of the sample of 316 children with VI, 198 had moderate VI and attended residential schools for children with VI in the Netherlands. Children and youths in residential schools may develop more friendships with each other, and there may be similarities in the way they perceive social acceptance and evaluations of appearances. Perceived lack of these domains may reduce healthy feelings of self-worth.

Some researchers suggested that parents and teachers played important roles in the development of identity, moral judgment, social interaction, and physical self-behavior among children with VI (Bowen, 2010b; Cardinali & D’Allura, 2001; Pinquart & Pfeiffer, 2013). The link between perceived acceptance and self-esteem may be important. Additionally, domain-specific competence, such as academic, social, athletic, physical, and behavioral competence, may differ in relation to age, gender, and diagnoses.

4.1. LimitationsThe aims, study design, participants, and measurement methods differed between the evaluated 26 studies. The studies also differed with respect to the ages of their participants and in the measure-ments of self-esteem and self-concept, which thus complicated comparisons. The presence of ad-ditional disabilities and the economic and cultural status of the participants in each study were not taken into account. However, despite the extensive literature on studies with sighted participants,

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research on self-concept and self-esteem may be flawed due to ambiguous definitions of the con-struct and lack of adequate instruments with which to measure it (Saigal et al., 2002).

A further limitation was that different definitions of VI were used in the studies. The majority of the publications (22) do not mention the diagnoses, progression of the disease, or the onset-age of vision loss, yet increasing severity of visual losses may lead to lower scores on self-concept and lower self-esteem (Bowen, 2010a).

In most studies, the age range of the participants was wide, which may have affected the results. Children’s emotional or behavioral performances differ according to different age and development stages (Papadopoulos, 2014; Pinquart & Pfeiffer, 2013). Therefore, the different results for self-es-teem and self-concept for children with VI may have been partly due to normal psychological devel-opment with increasing age for the studied children.

In addition, the majority of the studies evaluated were small, and limited to a specific geographi-cal area; only 7 studies included more than 100 children with VI. All of the studies had a cross-sec-tional design, except for three interventional studies (Bowen, 2010b; Shapiro et al., 2005, 2008). Therefore, the results could not be synthesized in a meta-analysis because of the small number and heterogeneity of the included studies. I suspect that bias due to selection or confounding may have occurred in at least some of the studies (e.g. Al-Zyoudi, 2007; Bowen, 2010b; Datta & Talukdar, 2016; Roy & MacKay, 2002; Shapiro et al., 2005, 2008). I strongly suspect there was bias in the studies that lacked randomization, especially those that included only a small convenience sample of children with VI. Unfortunately, many studies used this approach to obtain a more homogeneous sample. Thus, the study subjects may not have represented the target population. Conclusions of some stud-ies might not have been accurate in the cases where selection bias was not taken into account.

5. ConclusionsThe lack of longitudinal observational studies and randomized clinical trials limits the ability to draw conclusions about cause and effect. Some studies found that age and degree of vision loss influ-enced perceptions of self-esteem in children and young adults with VI. Social support, friendship, independence in mobility, and parenting and teaching style seemed to be important for helping children with VI to enhance their self-concept and self-esteem. In order to provide opportunities for successful development and healthy self-evaluation for children and young adults with VI, we need more knowledge and additional longitudinal and randomized studies of high quality.

5.1. Implications for practitionersThe findings may have implications for the education of children with VI as well as the provision of services for them. To achieve a good self-esteem and self-concept, it is important for children with VI to have more experiences of cooperation, independence in mobility, and more opportunities to attend activities with their peers. Furthermore, there is a need for a better understanding of the emotional and social needs of children with VI, in order to improve their self-esteem and to enhance their psychological self-evaluation and well-being. In a successful development process, all children can develop and become well adjusted, emotionally balanced individuals who have a positive per-ception of their self-esteem.

AcknowledgmentThe author thanks Catriona Turner for checking the language of the manuscript.

Funding The author received no direct funding for this research.

Author detailsLiv Berit Augestad1,2

E-mail: liv.berit.augestad@ntnu.noORCID ID: http://orcid.org/0000-0002-9466-5382

1 Faculty of Medicine and Health Science, Department of Neuromedicine and Movement Science (INB), The Norwegian University of Technology and Science (NTNU), NO-7491 Trondheim, Norway.

2 Department of Visual Impairment, Statped midt, Heimdal, Norway.

Citation informationCite this article as: Self-concept and self-esteem among children and young adults with visual impairment: A systematic review, Liv Berit Augestad, Cogent Psychology (2017), 4: 1319652.

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